Severity of Acute Illness is Associated with Baseline Readiness to Change in Medical Intensive Care Unit Patients with Unhealthy Alcohol Use

Authors

  • Brendan J. Clark,

    1. From the Division of Pulmonary Sciences and Critical Care Medicine (BJC, AS, ID, ELB, MM), University of Colorado Denver, Aurora, Colorado; Department of Psychiatry (RH), Denver Health Medical Center, Denver, Colorado; and Department of Medicine (ID), Denver Health Medical Center, Denver, Colorado.
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  • Alexandra Smart,

    1. From the Division of Pulmonary Sciences and Critical Care Medicine (BJC, AS, ID, ELB, MM), University of Colorado Denver, Aurora, Colorado; Department of Psychiatry (RH), Denver Health Medical Center, Denver, Colorado; and Department of Medicine (ID), Denver Health Medical Center, Denver, Colorado.
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  • Robert House,

    1. From the Division of Pulmonary Sciences and Critical Care Medicine (BJC, AS, ID, ELB, MM), University of Colorado Denver, Aurora, Colorado; Department of Psychiatry (RH), Denver Health Medical Center, Denver, Colorado; and Department of Medicine (ID), Denver Health Medical Center, Denver, Colorado.
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  • Ivor Douglas,

    1. From the Division of Pulmonary Sciences and Critical Care Medicine (BJC, AS, ID, ELB, MM), University of Colorado Denver, Aurora, Colorado; Department of Psychiatry (RH), Denver Health Medical Center, Denver, Colorado; and Department of Medicine (ID), Denver Health Medical Center, Denver, Colorado.
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  • Ellen L. Burnham,

    1. From the Division of Pulmonary Sciences and Critical Care Medicine (BJC, AS, ID, ELB, MM), University of Colorado Denver, Aurora, Colorado; Department of Psychiatry (RH), Denver Health Medical Center, Denver, Colorado; and Department of Medicine (ID), Denver Health Medical Center, Denver, Colorado.
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  • Marc Moss

    1. From the Division of Pulmonary Sciences and Critical Care Medicine (BJC, AS, ID, ELB, MM), University of Colorado Denver, Aurora, Colorado; Department of Psychiatry (RH), Denver Health Medical Center, Denver, Colorado; and Department of Medicine (ID), Denver Health Medical Center, Denver, Colorado.
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Reprint requests: Brendan J. Clark, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, RC2, Box C272, 9th Floor, 12700 E. 19th Avenue, Aurora, CO 80045; Tel.: 720-375-0608; Fax: 303-724-6042; E-mail: brendan.clark@ucdenver.edu

Abstract

Background:  Unhealthy alcohol use predisposes to multiple conditions that frequently result in critical illness and is present in up to one-third of patients admitted to a medical intensive care unit (ICU). We sought to determine the baseline readiness to change in medical ICU patients with unhealthy alcohol use and hypothesized that the severity of acute illness would be independently associated with higher scores on readiness to change scales. We further sought to determine whether this effect is modified by the severity of unhealthy alcohol use.

Methods:  We performed a cross-sectional observational study of current regular drinkers in 3 medical ICUs. The Alcohol Use Disorders Identification Test was used to differentiate low-risk and unhealthy alcohol use and further categorize patients into risky alcohol use or an alcohol use disorder. The severity of a patient’s acute illness was assessed by calculating the Acute Physiologic and Chronic Health Evaluation II (APACHE II) score at the time of admission to the medical ICU. Readiness to change was assessed using standardized questionnaires.

Results:  Of 101 medical ICU patients who were enrolled, 65 met the criteria for unhealthy alcohol use. The association between the severity of acute illness and readiness to change depended on the instrument used. A higher severity of illness measured by APACHE II score was an independent predictor of readiness to change as assessed by the Stages of Change Readiness and Treatment Eagerness Scale (Taking Action scale; p < 0.01). When a visual analog scale was used to assess readiness to change, there was a significant association with severity of acute illness (p < 0.01) that was modified by the severity of unhealthy alcohol use (p = 0.04 for interaction term).

Conclusions:  Medical ICU patients represent a population where brief interventions require further study. Studies of brief intervention should account for the severity of acute illness and the severity of unhealthy alcohol use as potential effect modifiers.

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